Acute Hepatitis Including Acute Liver Failure

Acute Hepatitis - Aetiological Considerations
Liver biopsy rarely identifies a previously unsuspected aetiology
• Biopsies mostly obtained from people in whom main recognised causes have been
excluded (“seronegative hepatitis”)
• Biopsy sometimes provides pointers to a previously unsuspected aetiology
Aetiology
Suggestive Histological features
Drugs • Disproportionately severe / well-circumscribed necrosis
(relatively little inflammation – lobular and/or portal)
• Unusual patterns of necrosis - e.g periportal (zone 1) necrosis
• Unusually prominent cholestasis
• Eosinophils, granulomas
Autoimmune
hepatitis
(Abe 2007, Fujiwara 2008,
Stravitz 2011, Yasui 2011)
• Plasma cell rich portal infiltrate (also seen in hepatitis A)
• Prominent periportal inflammation (interface hepatitis)
• Lymphoid aggregates
• Prominent centrilobular inflammation (“central perivenulitis”)